New medicines, mode might alter heroin treatment

In years to come, drug addiction will probably be treated like hypertension, diabetes and other chronic, relapsing diseases: with a variety of medications prescribed in the doctor's office.

This month, the Federal Drug Administration announced the approval of two prescription drugs for heroin addicts: buprenorphine (a partial opiate that produces minimal mood alteration) and buprenorphine-naloxone (a combination with an opiate blocker).

Studies over the past decade suggest that these medications may be as effective as methadone in reducing opiate use and retaining addicts in treatment programs.

Methadone - the treatment of choice since the 1960s - produces a high when taken orally, even more so when injected. But buprenorphine-naloxone does not produce euphoria when taken orally, and if injected it will actually make an addict feel sick. It also has a much lower potential for overdose and withdrawal symptoms than methadone, and it has to be taken less frequently - once every two to three days as opposed to daily.

Even more important, buprenorphine-naloxone can be dispensed in the privacy of a doctor's office, as a result of the Drug Addiction Treatment Act of 2000, which was written in anticipation of this new generation of medications.

The hope is that allowing addicts to avoid visits to centralized methadone clinics will remove the stigma from seeking treatment and that more patients will seek help in the early stages of their addiction.

Some experts say the new era in addiction treatment will inevitably affect the debate over the decriminalization of drugs. If heroin abuse comes to be seen as just another treatable condition, would heroin still be considered a social menace?

"The combination of developing and approving new anti-addiction drugs and the new law allowing their treatment in a private doctor's office represents a real sea change," said Alan Leshner, chief executive of the American Association for the Advancement of Science and the publisher of Science magazine.

"It is a flat-out demonstration that we are viewing addiction as a bona fide disease," Leshner said.

Methadone remains the gold standard in treating opiate addiction - especially for heroin users who have long-standing habits and require large doses. But medications like buprenorphine-naloxone provide patients with more choices and could prove especially helpful in the early stages of addiction.